I it • NYM.5324.08d Suicide Prevention Program U.S. Department of Justiee Federal Bureau of Prisons Metropolitan Correctional Center New York, NY 10007 Institution Supplement OPI: Psychology Department NUMBER: NYM5324.08d DATE: May 21, 2013 SUBJECT: Suicide Prevention Program 1. PURPOSE: The prevention of self-destructive behavior is an essential component in the care, custody, and control of the inmate population. The procedures outlined below will be implemented to avert the loss of life, and to diminish the potential for further suicidal behavior. 2. The stress associated with incarceration, as well as unpredictable stressful events, can result in the motivation to commit suicide. Early identification of self-destructive potential in conjunction with appropriate physical and mental health interventions and coordinated follow-up can reduce the likelihood of injury, fatality, and further self-destructive behavior. DIRECTIVES AFFECTED Directive Referenced: P.S. 5324.08 Suicide Prevention Program, dated April 5, 2007. Directive Rescinded: NYM 5324.05c, Suicide Prevention Program, dated December I. 2006. 3. RESPONSIBILITIES: The Chief Psychologist or his/her designee is designated as the Suicide Prevention Program Coordinator. 4. PROCEDURES: A. REFERRAL: All staff shall immediately refer potentially suicidal inmates to Psychology Services for evaluation. During non-regular working hours, the inmate will be referred to the Operations Lieutenant and the Physician's Assistant on duty. Should the Physician's Assistant determine that the inmate is at serious risk for inflicting self-harm, he/she will inform the CONFIDENTIAL SDNY_00009842 EFTA00034007

NYM.5324.08d Suicide Prevention Program Operations Lieutenant, who in turn, will contact the On-Call Psychologist who will determine if a suicide watch will be initiated. However, in an emergency situation if a Physician's Assistant is not available, any staff member can initiate a suicide watch. The Operations Lieutenant should immediately be contacted, who will then immediately contact the On-Call Psychologist. Psychology Services Inmate Questionnaire (PSIQ): This form (attachment 1) will be distributed in Receiving and Discharge during the intake screening process. Staff (Medical, Psychology, or Lieutenants) conducting the psychosocial interview will review the PSIQ for completion, check the inmate's response to item #7, i.e., "Are you considering suicide now?" and sign his/her name next to item #7. Outside of regular working hours and in the absence of any Psychologist at the institution, without exception, all inmates endorsing item #7 (current suicidal thoughts) or appearing to be potentially suicidal as determined by the staff member conducting the psychosocial interview, will be placed on suicide watch, pending direct interview by a Psychologist. The Operations Lieutenant will be contacted immediately and he/she will in turn notify the Psychologist as soon as possible about the new suicide watch. In the rare case the On-Call psychologist cannot be reached promptly, reasonable efforts should be made to contact another Psychologist. If there is a mid-level provider or Physician Assistant at the institution during non-routine hours, he/she will be called for further evaluation if the inmate endorses item #7, appears highly emotionally distressed, and/or displays unusual behavior (e.g., crying, shaking, talking to himself, paranoid, etc.). Airing routine working hours, the "duty psychologist" will be called immediately by radio for further evaluation of any inmate who endorses item #7, appears highly emotionally distressed, and/or displays unusual behavior. Referred inmates should be kept under direct observation of staff until the Psychologist arrives. B. MAINTENANCE: When a suicide watch is initiated, the suicidal inmate will be placed under continuous visual observation. The following maintenance procedures will be followed: When there is an inmate in the institution placed on a suicide watch, the suicide watch will be in the 2nd floor suicide prevention area and conducted by inmate companions, unless staff are required for the suicide watch. If staff are used for the suicide watch, there are Post Orders explaining the suicide watch procedures in detail that must be signed by all staff before they assume this post. Inmate companions may only watch suicidal inmates of the same gender. The Unit 2 Officer is responsible for making rounds and signing the suicide watch log every hour. FXCEPTIONS: The following exceptions to the above procedures will apply: 2 CONFIDENTIAL SDNY_00009843 EFTA00034008

C. NYM.5324.08d Suicide Prevention Program 1. All Unit 3 inmates placed on a suicide watch will be observed only on Unit 3 (cell C02-313) by Unit 3 inmate companions or staff only. 2. If a suicide watch is being conducted in the 2nd floor suicide prevention area, an inmate of the opposite gender will not be placed on suicide watch in the 2nd floor suicide prevention area. The suicide watch with an inmate of the opposite gender will be conducted in an alternate location. See #3 below for the alternate locations. Therefore, if there is a male inmate on suicide watch in the suicide prevention area and a female inmate suicide watch is initiated, the female inmate will be placed on Unit 2 (cell B01-211) with a female inmate companion. If there are two female inmates on suicide watch in the suicide prevention area and a male inmate suicide watch is initiated, the male inmate will be placed on 9 South (Z03-965, H tier, Hard cells #1, #2) on suicide watch with a staff member watching the inmate. 3. A suicide watch room waiver has been approved for alternate suicide watch rooms when needed other than the 2 suicide watch rooms in the suicide prevention area. They are as follows: Unit 2 (cell B01-211), Unit 3 (cell C02- 313), 9 South (cell Z03-965), and 10 South Lower — H tier (Hard cells #1 and #2). OPERATIONAL, PROCEDURES: 1. Suicide Watch Requirements: Before placing a suicidal inmate in a suicide watch room, the room will be thoroughly inspected and the inmate will be strip-searched to ensure that he/she does not have access to any items which could be used to injure him/herself or others. Normally potentially suicidal inmates will be required to wear a suicide watch gown. Unless otherwise specified by the Program Coordinator or her designee, the inmate will be allowed a suicide watch blanket. The inmate will never be allowed razors, shoelaces, belts, sheets, metal cans, or other sharp objects. In the suicide watch log book, there will be a list specifying items that the inmate may be allowed in the suicide watch room, as well as any special instructions for the management of the inmate on watch. 2. Monitoring and Psychological Interviews of Inmates on Suicide Watch: All inmates on Suicide Watch must be observed directly by staff or inmate companions at /ILL TIME'S. If inmate companions need to be removed from their Suicide Watch posts for any reason, a staff member will immediately assume the Suicide Watch post in order to continue direct observation of the inmate in the suicide watch cell. It is a fact, as reiterated by national policy; it takes only three to four minutes for many suicide deaths to occur. A Psychologist will interview the inmate on suicide watch daily, 3 CONFIDENTIAL SDNY_00009844 EFTA00034009

o NYM.5324.08d Suicide Prevention Program including weekends and holidays, and record clinical notes on the Psychology Data System (PDS) following each visit. 3. Documentation of Observations of Inmates on Suicide Watch: Observations of the inmate's behavior will be documented in a Suicide Watch Log Book, which will be maintained as a secure document. As stated by the Suicide Prevention Program Statement, staff and inmate observers will document in separate log books. Post Orders will provide direction to staff on requirements for documentation (e.g., entering log entries at least every 15 minutes). 4. Meals: Inmates on suicide watch will be fed sack meals to prevent their access to hard, breakable objects, hard containers, and plastic wrappings. 5. Showers: Showers are allowed for inmates on suicide watch unless specific mental health or security concerns are identified by Psychology Services or Correctional Services. The Operations Lieutenant will be responsible for supervising and coordinating showering procedures. Any showering restrictions, due to security concerns, must be directly conveyed to the Operations Lieutenant. Receipt of such instructions will be noted in the Suicide Watch Log Book. 1 I I 6. Searches of Suicide Watch Cells: At a minimum, suicide watch cells will be searched once a day, to extract any contraband, items not allowed in the cell, and/or accumulated trash. This search will normally be conducted by the Unit Officer during Day Watch, supervised by the Operations Lieutenant or designee. The Unit Officer will also search the suicide watch cell when the inmate exits the cell to take a shower. 7. Telephone Use: Inmates on suicide watch will not normally be permitted phone calls. Very seldom, phone calls may be recommended by Psychology Services staff as these phone calls may be deemed potentially beneficial to the inmate's mental health and/or may expedite recovery, and do not pose an increased risk for self-harm or harm to others. These rare exceptions must be approved by the Captain as well by the Associate Warden of Programs. Non-psychology staff recommending phone calls shall consult with Psychology Services staff, who if in agreement, will initiate proper procedures. 8. Visits and Recreation: Normally, neither recreation nor visitation (either social or legal) are permitted for inmates on suicide watch. Occasionally, visits may be recommended by Psychology Services staff, as these visits may be deemed potentially beneficial to the inmate's mental health and/or may expedite recovery, and do not pose an increased risk for self-harm or harm to others. These rare exceptions must be approved by the Captain as well by the Associate Wardens of Programs. 4 CONFIDENTIAL SDNY_00009845 EFTA00034010

NYM.5324.08d Suicide Prevention Program 9. Emergency Medical Trips: Emergency medical trips will be the responsibility of the Operations Lieutenant. 10. Court Trips: Court trips do not require approval from a Psychologist. Therefore, ordinarily, all inmates on suicide watch scheduled to go to court must be escorted to R&D to go to court. It will be the Operations Lieutenant's responsibility to notify the U.S. Marshals Service of any inmate on suicide watch who is scheduled to go to court. Any exceptions regarding inmates on suicide watch who are not permitted to go to court (i.e., actively suicidal and/or acutely psychotic), will be stated in writing by Psychology Services and/or Correctional Services. Every inmate who departs for court on suicide watch must beplaced back on suicide watch upon returning to the institution, pending re-evaluation by a Psychologist. 11. Escorting Procedures for Inmates on Suicide Watch: All inmates on suicide watch will be restrained when moved out of the suicide watch cell for showering, medical visits, court appearances, or legal visits. The level or type of restraints will be determined by Correctional Services. 12. Termination of Suicide Watches: Once an inmate has been placed on suicide watch, the watch may not be terminated, under any circumstance, without a Psychologist performing a face-to-face evaluation. Upon termination of a suicide watch, the Psychologist will provide the Operations Lieutenant with a memorandum documenting the ending of the watch and requesting removal of the inmate from the watch cell. 13. Housing Procedures for Inmates Discharged from Suicide Watch. All inmates discharged from suicide watch to a general population unit or the Special Housing Unit will be assigned a cellmate. If security and/or safety concerns preclude cellmate assignment, the Associate Warden of Programs will be contacted by the staff member recommending against cellmate assignment. The above procedures are to be strictly adhered to. Any deviation from established procedures must first be approved by the Associate Warden Operations and/or Programs. 1 D. INMATE COMPANIONS: The Program Coordinator will be responsible for the selection, training, assignment and removal of individual inmate companions. The following guidelines will be required for the use of inmate companions: 1. Male volunteers will be recruited from the sentenced inmates designated to Unit 5S and, if needed, pretrial/holdover inmates without separatees from 5 North. Male volunteers for the suicide watches on Unit 3 will be recruited from the Unit 3 inmates. Female volunteers will be recruited from inmates on Unit 2. All volunteers must be approved in advance by the Program Coordinator, who will consult with Unit 2, Unit 3, Unit 5S and Unit 5N Unit Managers. 5 CONFIDENTIAL SDNY_00009846 EFTA00034011

1 . 44—\ Cts, i I 1 1 I 1 NYM.S324.08d Suicide Prevention Program 2. There will be one inmate companion designated as the Inmate Coordinator on Unit 5S and one designated as an Alternate Inmate Coordinator, either on Unit 5S or Unit 5N. There will be one inmate companion designated as the Inmate Coordinator on Unit 2. The Inmate Coordinator is responsible for maintaining a current schedule of round-the- clock inmate companion assignments. Daily changes and additions will be maintained by the Inmate Coordinator. On Unit 3 there will be only 6 inmate companions and each one will be assigned a permanent 4-hour shift. The Inmate Companion schedule will be available to the Operations Lieutenant and the Unit 5S, Unit 5N, Unit 3, and Unit 2 Officers at all times. 3. Once a suicide watch has been initiated, the Operations Lieutenant will contact the Unit 5S, Unit 3, or Unit 2 Officer/Unit Staff to inform them that inmate companions will be used. The Inmate Coordinator will then be notified by the Unit Officer and told to inform all inmate companions of their assigned shifts for the next 24 hours. The Inmate Coordinator will then maintain round-the-clock assignments of inmate companions for as long as the suicide watch remains in effect. If an inmate companion refuses to work or cannot work his/her shift because of illness, the Inmate Coordinator is responsible for providing a replacement. If the Inmate Coordinator does not fulfill his/her responsibility in assigning inmate companions, the Operations Lieutenant will make the assignments. 4. Inmate companions will receive one dollar for each hour they monitor a suicide watch and forty cents for each hour they attend training classes. Payment will be made on a monthly basis. Hours worked and training sessions attended will be recorded by the Suicide Prevention Program Coordinator. 5. Inmate companions will be required to work their regular 8-hour work details in addition to their 4-hour suicide watch shift. Whenever possible, inmate companions will not be scheduled for a suicide watch during their regular work details. If unusual circumstances result in a conflict between an inmate companion's suicide watch and his work detail, then Unit 5S, Unit 5N or Unit 2 Officer will notify the Detail Supervisor of the reason for the inmate's absence. E. STAFF TRAINING: The Program Coordinator will ensure that all staff will be trained by psychology services personnel to recognize signs indicative of a potential suicide, the appropriate referral process, and suicide prevention techniques. At a minimum, this will occur during Annual Training. 1. Supplemental Specialty Training - Further training with regard to suicide prevention will ordinarily be conducted with Health Services staff, Lieutenants, and Correctional Counselors approximately six months after Annual Training. CONFIDENTIAL 6 SDNY_00009847 EFTA00034012

NYM.5324.08d Suicide Prevention Program 2. Supplemental Training for SHU Staff - Information about recognizing potentially suicidal inmates and procedures to follow will be included in the SHU post orders with a separate signature sheet. 1 3. Emergency Response Training - As indicated by the Suicide Prevention Program Statement, the Captain and the Chief Psychologist will conduct three joint mock exercises yearly, one on each shift, approximately four months apart. At least one of these exercises will take place in the SHU during the evening or morning watch. Ordinarily, this exercise will be coordinated between the Captain, and/or Emergency Preparedness Officer and the Chief Psychologist. 5. EFFECTIVE DATE: This Institutional Supplement is effective upon issuance. ar en DISTRIBUTION: Warden Associate Wardens Executive Assistant Department Heads Correctional Supervisors Union NERO Master File CONFIDENTIAL 7 SDNY 00009848 EFTA00034013